Town Owned Nursing Home: Balancing Finances, Staff Reductions, Vaccine Reluctance, Patient Safety Amid Covid

This week, during the monthly board meeting of the Nathaniel Witherell, the Town of Greenwich owned nursing home, again there was discussion about staff vaccination levels, staff reductions and the ongoing desire of loved ones to have indoor visitation – all given the backdrop of the Covid-19 pandemic and preparations for a possible sale of the facility.

The Nathaniel Witherell has operated at an annual deficit in the millions of dollars annually.

Multiple families with loved ones at the Witherell have contacted GFP to say that since January, due to a string of outbreak testing triggered each time there is a positive Covid test among Witherell staff, they have had restrictive visitation. They say un-vaccinated staff are to blame.

Family members said they were also disappointed about the continued isolation of their loved ones who they say are still mostly in their rooms, eating in their rooms and rarely allowed off their floors.

Further, family members who are fully vaccinated themselves find it difficult to reconcile being kept apart from loved ones while many staff remain reluctant to be vaccinated.

During last week’s Board meeting via Zoom, board member Nisha Hurst said 63.8% of staff were vaccinated overall. There are 279 staff. Of that number there are 150 full time employees, of which she said 118 are vaccinated. There are 129 part time staff. Of them, 60 are vaccinated. There are 196 nursing staff who interact directly with residents. Of the 115 full time nurses, 87 are vaccinated. Of the 81 part-time nurses, 38 are vaccinated.

Dr. Frank Walsh reported that 92% of residents had been vaccinated. He said new residents are tested before they move in.

As for staff reductions, Director John Mastronardi said instead of a ratio of 6 residents to 1 CNA, they are now operating with an 8 to 1 ratio. Typically, he said, the standard for skilled nursing facilities is a ratio of 12 to 1, but that was not being recommended.

He said on the Main and Garden levels there were 21 and 22 residents respectively, and those have remained the same with 3 Certified Nursing Assistants (CNA) on each of those floors, which is a 7-to-1 ratio.

He said 3 PCC positions had been cut. Now, 1 PCC handles the first and second floor, 1 PCC handles the 3rd and 4th floor, and 1 PCC handles the Main and Garden levels.

“We’re adding 3 LPNs who are coming on board in May and increasing our pool of part-time nurses to provide back fill and relief coverage when scheduled nurses call out,” Mastronardi added.

Board member Richard Kaplan asked whether the Witherell would maintain its 5-Star rating given the new staffing levels.

Mastronardi said the 5-Star rating was predominantly RN-based, so the cuts did not impact it.

Visitation

Mastronardi said the Witherell was encouraging outdoor visitation in pods, as well as in the auditorium, solarium and the library – in that order.

He said room visits were allowed, but visitors were being encouraged to meet with their loved ones outdoors, based on CMS guidance.

Also, per CMS guidance he said, “Visitors shouldn’t walk around different halls of the facility. They should go directly to the resident’s room or designated visitation areas. Visits for residents who share a room should not be conducted in the the resident’s room if possible, per the guidance.”

This week the Witherell website features an alert saying The Nathaniel Witherell is restricting all indoor visitation, including volunteers.

“We are not preventing visitors from going to rooms if they must see their loved one in their room. Also communal dining is taking place on long term care units, but not to pre pandemic levels. We’re staggering the seating times and the number of residents at any one sitting,” Mastronardi said, adding that a full time therapeutic recreational team facilitates activities and two full time musicians sing and play music for residents.

“I know there has been some misinformation, and I want to clarify that as far as visitation,” he continued. Are we opening up the doors and having all of the activities that we had pre pandemic? No. But we are making sure that all those on-unit activities are taking place.”

Lengthy Emails with Families

Mr. Kaplan suggested putting additional information on the Witherell website, including information on visitation, so people understand what to expect and to cut down on emails.

Ms Hurst asked Mr. Mastronardi how the board could be more helpful.

Mr. Mastronardi asked board members not to engage in one-on-one emails with residents’ family members because it was time consuming and a distraction from taking care of residents.

“I understand how people are feeling, but at the same time I think that using email as a forum – if we could stop having those conversations and for board members and team members, to not engage in that, I know there is a lot of emotion involved, I feel that too. I feel the team feels truly, for want of a better term, feels really beat down. I understand everyone wants to help, but I feel those kinds of discussions, we should be taken off line.”

“I prefer that we not engage via email. It’s not productive and escalates situations (and) some of them are very private,” Mastronardi added.

“Please temper your judgement and thinking before you respond,” he added.And feel free really to reach out to Nadia (Nadia Benson, Director of Nursing) and me.”

Mr. Kaplan said the Board supported Mr. Mastronardi, and that when he was hired, he was told the financial success of the facility was to be his top priority.

“Our concern was, you better make sure the building is around in a year,” he said.

“Everyone is looking all the time at how much we spend. How much do we make? How much does the town have to put up? We were pretty clear with you, first and foremost let’s get this thing under control financially. And the pandemic came,” Kaplan added.

During the pandemic the facility’s census took a hit, as did all nursing homes.

“We can financially change the direction this facility was going in, and keep a 5-star rating,” Kaplan continued. “And you have tried to that as best you could. As a board, our role is to help you do that. You’re the captain of the ship.”

“What else can we do constructively?” asked Board member Joan Merrill.

Mastronardi said he’d like support for residents who have no visitors.

“I’m going to be honest, but that fell by the wayside,” Mastronardi said. “I personally and professionally thought that if we could have support from the Board and the Family Council, in getting some of the folks that don’t see anybody, they unfortunately don’t have family members, or friends or loved ones. I feel for them.”

An email from Mary Cronin of Harrison Edwards PR & Marketing, relayed replies from Mr. Mastronardi to GFP questions about visitation, outbreaks/lockdowns, and a possible mandate for staff vaccinations.

“Our goal at the Witherell is to consistently maintain family visitation, and we’ve been able to do so throughout this period. A positive COVID test from any staff member, resident, or outside vendor has never prevented family members from visiting outdoors,” he said. “If anyone at our facility tests positive for COVID, we immediately assess the risk to our residents, and conduct facility-wide testing. This ‘outbreak testing’ requires that we suspend INDOOR visitation only for a period of 7-days. The last time indoor visitation was impacted by outbreak testing was on 4/2/21. We then resumed indoor visitation on 4/12/21. Outdoor visitation continued throughout this period.”

Further he said, “All family member visit requests are accommodated. The Witherell does not deny requests for visitation by family members.”

As for staff vaccination levels, Mastronardi said The Witherell’s staff vaccination levels are, in actuality, quite high and outpace the national average.

“As of this writing, 79% of our full-time staff is vaccinated. Overall, 72% of our staff (full and part-time) is vaccinated. In addition, 93% of residents are vaccinated.”

He explained why they have not opted to make vaccinations mandatory.

“As a facility owned and operated by the Town of Greenwich, we have had discussions with our legal counsel, human resources department, and employee union representatives about mandating vaccines. After careful consideration, all parties are in agreement that posing a mandate could have a negative impact on our staffing levels, and could spur legal action. Since we were able to effectively double our staff vaccination levels over a one-month period through the support of First Selectman Fred Camillo’s office, the decision was made to continue with our plan of education and engagement to overcome vaccine reluctance.”

At the end of March, Greenwich Dept of Health Director Caroline Baisley said during the Board of Health meeting that the town had partnered with the Family Centers twice to for vaccinations, with one being a clinic at the Nathaniel Witherell after concern was raised at their March board meeting that just 38.8% of staff had been vaccinated. She said about 85 people were vaccinated at the Witherell, though she did not say how many were to residents versus staff.

Mastronardi, in his forwarded email replies, said to keep in mind that some employees, and even some residents, may refuse the vaccine based on religious or medical conditions.

“Our plan is consistent with our corporate culture which reflects support, kindness, and empathy that extends to everyone who comes in contact with our facility. As a result of our culture, The Witherell’s staff retention levels are six times higher than the Connecticut state average. Many of our employees have worked their entire careers at the Witherell, which translates into higher quality, consistent care that helps our residents forge strong emotional bonds with their caregivers.”

“Throughout the pandemic, the Witherell has worked hard to provide solutions that safeguard the health of our residents, staff, and visitors, while also offering convenience to empower essential family connections. We continue to reassess, react, and respond to a very fluid situation with the best interests of our beloved residents and their dedicated family members as our top priority.”

See also:

Pressure Mounts on Witherell Staff to Get Vaccinated; Staff Cuts Announced

March 23, 2021